What are NHS Foundation Trusts (FTs)?

NHS Foundation Trusts are not-for-profit, public benefit corporations. They are part of the NHS and provide over half of all NHS hospital, mental health and ambulance services.

NHS Foundation Trusts were created to devolve decision making to local organisations and communities. They provide and develop healthcare according to core NHS principles - free care, based on need and not ability to pay.

NHS Foundation Trusts are:

free from central government control and are able to decide how to improve their services;

able to retain any surpluses they generate to invest in new services, and borrow money to support these investments;

accountable to their local communities through their Members and governors, their commissioners through contracts, Parliament, the Care Quality Commission and Monitor.

Why have NHS Foundation Trusts been set up?

They are being set up to ensure a more responsive approach to patients' needs. The ultimate goal is for NHS organisations to provide fast, convenient and high-quality care. This can only be achieved if future changes and plans are led by the community itself.

Is the RUH still part of the NHS?

What are the benefits to patients?

Benefits can be realised both directly and indirectly:

Directly, patients, carers, staff and the public can get involved in how RUH is run. They can help shape health services in the area, improve local services and help realise local needs and priorities. They can do that by becoming a Member of the Trust or a Governor.

Indirectly, NHS Foundation Trusts have more freedom and greater flexibility to plan and develop services around the needs of local people. In the long term all this means that the hospital will be able to offer:

What difference will being an NHS Foundation Trust make to the RUH?

Having local people, patients and staff on the council of governors encourages the hospital to concentrate more on the needs of its local communities. NHS Foundation Trusts have more financial freedoms to develop their services in the way they want; for example retaining any surpluses at the end of a financial year or raising capital money outside the current NHS approval processes.

Who runs the RUH Bath NHS Foundation Trust?

The Trust is run by the Trust Board made up of the Chair, Chief Executive, Executive and Non-Executive Directors. Our performance and strategy is overseen by a Board of Governors and ultimately the independent regulator, Monitor. Governors do not undertake operational management of NHS Foundation Trusts; rather they collectively hold to account the Board of Directors for the Trust's performance and advise on its future development.

What are the benefits for patients and what does it mean for the staff?

As an FT, we no longer report to the Trust Development Authority (TDA). We have more control to ensure that decisions which affect the RUH are made by us.

We have become a member-led organisation, giving patients, staff and the public a say in how we are run and what our priorities are and should be.

In order to achieve FT status, the RUH demonstrated it has strong financial foundations. Being an FT allows us to retain any surpluses we make and borrow to invest in new, improved services for patients.

Is being an FT all about money?

No, it's not; it's all about the patients. We have no reason to want to keep our surplus other than to plough it back into improving our services to make them better for our patients. We feel we should be able to make a surplus, and invest it, rather than having to give it back.

Are NHS Foundation Trusts still relevant?

The reality is that it is now harder than ever to become an FT, and FT status has come under greater scrutiny. In becoming an FT in 2014, we were the first hospital to be awarded FT status by Monitor in 16 months. FT status is still a benchmark for quality and reputation. Becoming an FT was not the final goal – it was the next step on our quality improvement journey.

How are NHS Foundation Trusts governed?

Who regulates Foundation Trusts?

NHS Foundation Trusts are regulated by Monitor, the sector regulator for health services in England. Monitor's job is to make the health sector work better for patients. It monitors the continuing performance of foundation trusts to ensure they are keeping to required standards, and, if there are signs a trust is struggling Monitor steps in to help make sure problems don't get worse.

The Care Quality Commission inspects all NHS Trusts and NHS Foundation Trusts to ensure services are of the highest quality.

How old do you have to be to become a Member?

Sixteen is the youngest age at which somebody can become a member of our FT. Given the responsibilities of a Member we have decided the age limit should be 16. The RUH provides services for children and young people and is keen to hear about their experiences. We are looking into providing a system that takes into account the views of younger people.

Will becoming a Member cost me anything?

How will local people become more involved in the running of the Trust?

Our Members democratically influence the development of the Trust through the Council of Governors. The majority of the Council of Governors is elected by the Members to better represent the views of the membership and public. Governors go to regular meetings about the Trust's plans for the future to represent Members' views and also hold the Non-Executive Directors to account for the performance of the Board of Directors. The Governors help to elect the Trust's Chairman and Non-Executive Directors and approve the appointment of the Chief Executive.

What are the benefits of being a Member?

Being a Member provides you with the opportunity to influence how the hospital is run and the services that it offers. Membership is completely free and it is up to you how involved you would like to be.

Through the Council of Governors, Members are given a greater say in the development of the hospital and can have a direct influence in the development of services within the hospital. Further benefits are outlined below:

Help the Trust to improve services by sharing their views and indicating where improvements could be made or where things could be done differently;

Be involved and consulted on issues such as changes and improvements to services;

Keep up to date with Trust news by receiving the Trust's quarterly magazine, Insight (this is circulated by email if we have the Member's email address);

What is a Governor?

A Governor is an elected member of the public that represents the interests of the community, patients, carers and the public as well as the Members of the Trust. Any member of the public can become a Member of the Trust and stand to be a Governor.

What does the Council of Governors do?

Governors have various statutory duties, such as appointing the Chair and Non-Executive Directors, approving the appointment of the Chief Executive, as well as appointing auditors and receiving accounts.

The Council of Governors also:

Feeds back information from the Members on service plans, initiatives, change of services etc;

Guards the values of the organisation and holds the non-executive directors to account for the performance of the board;

Is responsible for helping to engage Members and the community in the future development of the hospital.

How do Members become Governors?

In order to stand for election to become a Public or Staff Governor you must be a Member of the NHS Foundation Trust and over 18 years of age. To stand for election you must complete nomination papers. Ballot papers are posted to Members of the NHS Foundation Trust for them to choose who they would like to represent them on the Council of Governors.

Will I get paid to be a Governor?

What is the difference between the Board of Directors and the Council of Governors?

The Board of Directors is separate from the Council of Governors. The Board of Directors is appointed and is made up of members of staff in salaried posts. The Board of Directors is a statutory body of the Trust. The Council of Governors holds the Non-Executive Directors to account for the performance of the Board, it is democratically elected, and is made up of unpaid posts. The Council of Governors approves the appointment of the Chair and Chief Executive of the RUH.

How will you avoid wholesale change of the Council of Governors at the end of their three year appointments?

What support will there be for Governors in helping them engage with the Trust?

Once appointed, governors receive support by attending a programme of induction as well as receiving training and development opportunities throughout their term of service. They are fully supported to carry out their work by the Trust's Membership Office.